Abstract

Background

Australia's Aboriginal and Torres Strait Islander (Indigenous) populations have disproportionately
high rates of adverse perinatal outcomes relative to other Australians. Poorer access
to good quality maternal health care is a key driver of this disparity. The aim of
this study was to describe patterns of delivery of maternity care and service gaps
in primary care services in Australian Indigenous communities.

Methods

We undertook a cross-sectional baseline audit for a quality improvement intervention.
Medical records of 535 women from 34 Indigenous community health centres in five regions
(Top End of Northern Territory 13, Central Australia 2, Far West New South Wales 6,
Western Australia 9, and North Queensland 4) were audited. The main outcome measures
included: adherence to recommended protocols and procedures in the antenatal and postnatal
periods including: clinical, laboratory and ultrasound investigations; screening for
gestational diabetes and Group B Streptococcus; brief intervention/advice on health-related
behaviours and risks; and follow up of identified health problems.

Results

The proportion of women presenting for their first antenatal visit in the first trimester
ranged from 34% to 49% between regions; consequently, documentation of care early
in pregnancy was poor. Overall, documentation of routine antenatal investigations
and brief interventions/advice regarding health behaviours varied, and generally indicated
that these services were underutilised. For example, 46% of known smokers received
smoking cessation advice/counselling; 52% of all women received antenatal education
and 51% had investigation for gestational diabetes. Overall, there was relatively
good documentation of follow up of identified problems related to hypertension or
diabetes, with over 70% of identified women being referred to a GP/Obstetrician.

Conclusion

Participating services had both strengths and weaknesses in the delivery of maternal
health care. Increasing access to evidence-based screening and health information
(most notably around smoking cessation) were consistently identified as opportunities
for improvement across services.